Provider Demographics
NPI:1235449604
Name:BROWN, BRENDA (LPN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 GOETHALS RD N APT H5
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1426
Mailing Address - Country:US
Mailing Address - Phone:718-494-3073
Mailing Address - Fax:718-494-3073
Practice Address - Street 1:34 BEACH ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2702
Practice Address - Country:US
Practice Address - Phone:718-815-8089
Practice Address - Fax:718-815-8062
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294354-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse